Chirurgia最新文献

{"title":"A Rare Case of Gastric Cancer Following Sleeve Gastrectomy with Transit Bipartition Surgery: A Case Report and Review of the Literature.","authors":"Sertaç Ata Güler, Mariya Maşta, Ecenur Varol, Enes Şahin, Turgay Şimşek","doi":"10.21614/chirurgia.3202","DOIUrl":"https://doi.org/10.21614/chirurgia.3202","url":null,"abstract":"<p><p><b>Background:</b> Gastric cancer is a critical concern for public health. In particular, an increased incidence of gastric malignancies has been linked to previous gastric surgeries. Case Report: We report a case of cancer developing at the gastrojejunostomy site in a 75-year-old woman who underwent laparoscopic transit bipartition sleeve gastrectomy (TB-SG) seven years ago due to morbid obesity and type 2 diabetes mellitus. The patient underwent gastroscopy, biopsy, and computed tomography. Following neoadjuvant therapy, total gastrectomy with esophageal jejunostomy was performed. Postoperative nutritional support was provided with total parenteral nutrition. Enteral feeding was initiated on the eighth postoperative day, and the patient was discharged in stable condition on the twelfth postoperative day. Positive metabolic outcomes were recorded in the early postoperative period; the patient is being followed up less than one year postoperatively. <b>Discussion:</b> While bariatric surgery has been reported to contribute to a reduction in cancer incidence in certain settings, gastric cancer developing in the remaining stomach after bariatric surgery has rarely been documented. Several cases of gastric cancer have been identified after sleeve gastrectomy alone. Although cancer developed in the gastric remnant after sleeve gastrectomy and transit bipartition (TB-SG) surgery has been already reported in literature, this is the first case report of gastric cancer developed at the gastrojejunostomy anastomosis site after TB-SG. Conclusion: Tumor development at the anastomosis site following Sleeve Gastrectomy with Transit Bipartition is a rare occurrence. To prevent severe complications, patients undergoing this procedure should be closely monitored for gastric cancer during the postoperative period. Even minor clinical suspicions should prompt timely endoscopic and imaging evaluations without delay to facilitate early diagnosis.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 3","pages":"358"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical and Molecular Insights into Sarcopenia in Liver Cirrhosis: A CT-Based and Biomarker Case-Control Study.","authors":"Costel-George Gherghescu, Radu Andrei Baz, Constantin Dina, Andrei Dumitru, Georgeta Camelia Cozaru, Mihaela Manea, Ioana Popescu, Ana-Maria Grigorescu, Stere Popescu, Eugen Dumitru","doi":"10.21614/chirurgia.3325","DOIUrl":"10.21614/chirurgia.3325","url":null,"abstract":"<p><p><b>Background:</b> Sarcopenia is a common complication and an important negative prognostic factor in patients with liver cirrhosis, being associated with reduced muscle mass and function, as well as increased mortality. Although computed tomography (CT) is considered the gold standard for assessing muscle mass, there is growing interest in identifying serum biomarkers that may facilitate the early diagnosis and monitoring of disease progression. The aim of this study was to evaluate the diagnostic value of osteonectin, the C-terminal agrin fragment (CAF), the N-terminal propeptide of type III procollagen (P3NP), and myostatin in patients with liver cirrhosis and sarcopenia, in correlation with CT-derived imaging parameters. <b>Materials and Methods:</b> A prospective observational caseâcontrol study was conducted, including 60 participants: 30 patients with liver cirrhosis (with or without hepatocellular carcinoma) and sarcopenia, and 30 healthy control subjects. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria, using the skeletal muscle index (SMI) and psoas muscle index (PMI) measured by computed tomography. Serum concentrations of osteonectin, CAF, P3NP, and myostatin were determined using enzyme-linked immunosorbent assay (ELISA). Statistical analyses included parametric and non-parametric tests, as well as Pearson correlation analysis. <b>Results:</b> Patients with liver cirrhosis and sarcopenia exhibited significantly higher serum levels of osteonectin, CAF, P3NP, and myostatin compared with healthy controls (p 0.001 for all comparisons). The skeletal muscle index was significantly lower in cirrhotic patients, confirming the presence of muscle wasting. Correlation analysis demonstrated positive associations between osteonectin and CAF (r = 0.441, p 0.001), osteonectin and P3NP (r = 0.313, p = 0.016), osteonectin and myostatin (r = 0.444, p 0.001), as well as a strong correlation between CAF and myostatin (r = 0.882, p 0.001). No significant associations were observed between biomarker levels and viral etiology or ChildâPugh class. <b>Conclusions:</b> Simultaneous assessment of osteonectin, CAF, P3NP, and myostatin, combined with computed tomography-based imaging evaluation, may improve the diagnosis of sarcopenia associated with liver cirrhosis and facilitate the early identification of patients at increased risk of muscle deterioration. Larger multicenter prospective studies are warranted to validate the clinical utility of these biomarkers in routine medical practice.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 3","pages":"309-320"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COLOSSUS-AI: A Pilot Study on Artificial Intelligence Driven Prediction of Postoperative Outcomes in Colorectal Surgery.","authors":"Marian Botoncea, Cătălin Dumitru Cosma, Cosmin-Lucian Nicolescu, Vlad-Olimpiu Butiurca, Dragoţ Molnar, Călin Molnar","doi":"10.21614/chirurgia.3345","DOIUrl":"10.21614/chirurgia.3345","url":null,"abstract":"<p><p><b>Background:</b> Postoperative complications remain a major source of morbidity after colorectal surgery and are associated with prolonged hospitalization, reintervention, intensive care unit admission, and increased mortality. Early identification of high-risk patients remains challenging due to the heterogeneity of colorectal surgical populations. Artificial intelligence and machine learning methods may support individualized risk prediction by integrating clinical, biological, and operative variables. Aim: This study aimed to develop and internally evaluate a preliminary machine learning model, named COLOSSUS-AI, for predicting early postoperative adverse outcomes after colorectal surgery. Material and <b>Methods:</b> This retrospective, single-center, observational pilot study included 310 patients undergoing colorectal surgery. Demographic, clinical, laboratory, disease-specific, operative, and postoperative data were retrospectively collected and organized into a structured database comprising 84 variables. The primary endpoint was postoperative adverse outcome. Three predictive models were evaluated: logistic regression, random forest, and gradient boosting. Model performance was assessed using receiver operating characteristic curve analysis, area under the curve, accuracy, sensitivity, and specificity. <b>Results:</b> Postoperative adverse outcomes occurred in 120 patients (38.7%). Adverse outcomes were associated with older age, urgent or emergency admission, increased inflammatory markers, higher neutrophil-to-lymphocyte ratio, lower preoperative albumin, impaired renal function parameters, anastomotic leak, and in-hospital mortality. Among the evaluated models, gradient boosting achieved the best predictive performance, with an area under the receiver operating characteristic curve of 0.886, accuracy of 81.7%, sensitivity of 72.2%, and specificity of 87.7%. Random forest achieved an area under the curve of 0.841, while logistic regression achieved an area under the curve of 0.768. <b>Conclusions:</b> The COLOSSUS-AI pilot study suggests that routinely collected perioperative data can be used to develop exploratory machine learning models for predicting postoperative adverse outcomes after colorectal surgery. Although gradient boosting showed the best preliminary performance, these findings should be interpreted cautiously. External validation in larger multicenter cohorts is required before clinical implementation.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 3","pages":"268-277"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Removal of a Gastric Trichobezoar in Adulthood: A Case Report.","authors":"Serhii Savoliuk, Dmytro Zavertylenko, Andrii Dembitskyi, Illya Karabayev","doi":"10.21614/chirurgia.3270","DOIUrl":"10.21614/chirurgia.3270","url":null,"abstract":"<p><p>Trichobezoars are hair concretions in the stomach associated with trichophagia and trichotillomania. In most cases, they occur among young women with concomitant mental disorders. The treatment for this category of patients involves surgical removal of trichobezoars. We present a case of a 24-year-old female patient who complained of morning nausea, a sensation of a foreign body, and periodic pulling pain in the epigastric region. Palpation revealed a foreign mass that occupied the epigastric area. The patient underwent computed tomography (CT) and esophagogastroduodenoscopy (EGD) for differential diagnosis. Based on the instrumental studies, the diagnosis of a gastric trichobezoar was established. Laparoscopic gastrotomy was performed along the anterior wall of the stomach with removal of the trichobezoar through a Pfannenstiel-type mini-laparotomy site. The postoperative period was uneventful, and the patient was discharged on the second postoperative day. To prevent recurrence, psychiatric consultation and long-term outpatient follow-up were recommended as part of treatment. The uniqueness of this case lies in the presence of a trichobezoar that caused minimal discomfort for a long period of time. Laparoscopic removal of gastric trichobezoars represents an effective treatment option due to its minimally invasive nature and rapid postoperative recovery.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 eCollection","pages":"1"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Management of Delayed Pediatric Nail Puncture Injury Complicated by Severe Soft-Tissue Infection: The Adjunctive Role of Negative Pressure Wound Therapy","authors":"Viktor Marku, Chrysa Andrikopoulou, Ioannis Fragkakis, Vasileios Leivaditis, Theodora Skoura, Panagiotis Antzoulas, Konstantinos Tasios, Elias Liolis, Andreas Antzoulas, Dimitrios Litsas, Panagiotis Dimitrios Papadopoulos, Thomaella Tsouvaltzidou, Sosanna Ierodiaconou, Konstantinos Nikolakopoulos, Spyros Papadoulas, Agron Dogjani, Francesk Mulita","doi":"10.21614/chirurgia.3326","DOIUrl":"10.21614/chirurgia.3326","url":null,"abstract":"<p><strong>Background: </strong>Puncture wounds in children are frequently underestimated, particularly when presentation is delayed or the\u0000initial injury goes unnoticed. Retained foreign bodies substantially increase the risk of deep soft-tissue infection, abscess formation, septic arthritis, and osteomyelitis. Prompt diagnosis and appropriate surgical management are essential to prevent serious complications.</p><p><strong>Case presentation: </strong>A 4-year-old child presented with a 10-day history of progressive pain, swelling, erythema, and purulent\u0000discharge of the right foot following a nail puncture injury. Clinical and radiological evaluation revealed extensive soft-tissue\u0000infection associated with retained foreign material. Following aggressive surgical debridement, foreign-body removal, and\u0000irrigation, empirical intravenous antimicrobial therapy was initiated and subsequently guided by microbiological culture\u0000results. Negative pressure wound therapy (NPWT) using a vacuum-assisted closure (VAC) system was applied for\u0000three weeks. At one-month follow-up after completion of NPWT, the wound demonstrated complete coverage with healthy\u0000granulation tissue, marked reduction in wound size and depth, resolution of infection, and satisfactory functional recovery\u0000without the need for further surgical intervention.</p><p><strong>Conclusion: </strong>This case highlights the importance of early recognition and comprehensive management of delayed pediatric\u0000puncture wounds. Combined surgical debridement, appropriate antimicrobial therapy, and adjunctive NPWT can effectively\u0000control infection, promote wound healing, and facilitate successful limb preservation in complex pediatric soft-tissue injuries.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 eCollection","pages":"1"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148307167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-Stage Surgical Treatment of Penile Squamous Cell Carcinoma: Primary Tumor and Nodal Management Outcomes in a Retrospective Cohort.","authors":"Andrei Andreşanu, Constantin Gîngu, Mihaela Roxana OliţÃ, Mihai Adrian Eftimie, Mihai Adrian Dobra, Bogdan Marian Sorohan, Bogdan Obrişcă, Dragoş Eugen Georgescu, Ioanel Sinescu","doi":"10.21614/chirurgia.3275","DOIUrl":"https://doi.org/10.21614/chirurgia.3275","url":null,"abstract":"<p><p><b>Background:</b> Multi-stage surgical management of penile squamous cell carcinoma (PSCC) requires sequential decision-making from primary tumor treatment through extensive lymphadenectomy, the lack of adherence to treatment indications and prognostic stratification remaining clinical challenges. This study assessed outcomes and prognostic determinants in patients undergoing staged surgical treatment. <b>Methods:</b> This retrospective cohort study analyzed 49 patients with surgically treated PSCC with surgical indication for bilateral inguinal-femoral lymphadenectomy (ILND) following curative-intent primary tumor resection between October 2020 and December 2024 in a tertiary Romanian oncological surgery center. Primary endpoints included overall survival (OS), treatment completion rates, and prognostic factor identification through univariate and multivariate Cox regression analysis. <b>Results:</b> Among 49 patients (median age 64 years), 31 (63.3%) completed second-stage bilateral ILND, while 18 (36.7%) remained non-compliant. Pathological staging revealed pN0-N1 in 36.7%, pN2 in 42.9%, and pN3 in 20.4%. Eleven patients (22.4%) underwent third-stage pelvic lymphadenectomy (PLND). Overall mortality reached 55.1% (27/49) with median OS of 20 months. Patients requiring third-stage pelvic dissection demonstrated 90.9% mortality and median OS of only 12 months. Multivariate analysis identified three independent prognostic factors for OS: absence of lymphovascular invasion (LVI) (HR 0.43, 95% CI: 0.19-0.99, p = 0.048), absence of urethral invasion (HR 0.36, 95% CI: 0.12-1.03, p = 0.056), and pathological N stage. Each additional positive lymph node increased mortality hazard by 4% (HR 1.04, 95% CI: 1.01-1.06, p = 0.002). <b>Conclusions:</b> Multi-stage surgical management of PSCC faces a low level of patient compliance (63.3%) and identifies high-risk populations through staged progression. While LVI, urethral invasion, and nodal stage provide independent prognostic stratification, patients meeting third-stage pelvic dissection criteria exhibit poor outcomes despite complete surgical staging, suggesting these patients may benefit more from integrated systemic therapy approaches than from extended surgery alone.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 3","pages":"296-308"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thirty Years of Minimally Invasive Colorectal Surgery at the Fundeni Clinical Institute: An Institutional Experience.","authors":"Ioana-Maria Ignat, Corina-Elena Minciună, Daniel Gavrilă, Cătălin Vasilescu","doi":"10.21614/chirurgia.3304","DOIUrl":"https://doi.org/10.21614/chirurgia.3304","url":null,"abstract":"<p><p><b>Background:</b> Minimally invasive colorectal surgery has evolved considerably in our country over the past three decades, although its early adoption was slow and uneven in many centers. At the Fundeni Clinical Institute, this evolution began in 1995 with the first reported laparoscopic colorectal operation performed in Romania, marking the start of a gradual transition from the open approach to minimally invasive surgery for both colonic and rectal pathology. <b>Methods:</b> We conducted a retrospective institutional review, integrating historical milestones, published experience, and analysis of internal databases. Laparoscopic, robotic-assisted, and transanal techniques were evaluated, with emphasis on oncologic colorectal surgery and the progressive expansion of minimally invasive indications. <b>Results:</b> After an initial period of cautious and limited dissemination, minimally invasive colorectal surgery progressively expanded as surgical expertise and technological resources improved. The adoption of advanced laparoscopic procedures, including the laparoscopic reversal of the Hartmann procedure and various transanal techniques, reflected the extension of minimally invasive colorectal practice beyond selected cases to more complex colorectal surgery. Between 2012 and 2023, 2,447 rectal cancer resections were performed, of which 446 were minimally invasive. After discontinuation of the robotic program, laparoscopic surgery served as the sole minimally invasive approach and was paradoxically associated with a further increase in minimally invasive procedures, despite the absence of robotic surgery, without compromising oncologic or postoperative outcomes. <b>Conclusions:</b> The experience of the Fundeni Clinical Institute illustrates the successful maturation of minimally invasive colorectal surgery from an early pioneering stage to a stable and expanding practice. Despite initial limitations and the discontinuation of the robotic program, laparoscopic surgery became the main driver of minimally invasive procedures, enabling their extension to more complex cases without compromising oncologic or perioperative outcomes. This evolution highlights the instituteâs role in consolidating minimally invasive colorectal surgery as a reliable standard in a high-volume center.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 3","pages":"278-285"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic Closed-Incision Negative Pressure Wound Therapy (ciNPWT) in Breast Surgery: A Pilot Study on the Prevention of Surgical Site Complications.","authors":"Marco Yusef, Luca Improta, Augusto Lombardi, Valeria Vitale, Gianluca Stanzani, Francesco Maria Carrano, Virginia Di Donato, Gianfranco Silecchia","doi":"10.21614/chirurgia.3346","DOIUrl":"10.21614/chirurgia.3346","url":null,"abstract":"<p><strong>Aim: </strong>Surgical wound complications remain a relevant issue in breast surgery, particularly in patients with risk factors such as obesity. Closed-incision negative pressure wound therapy (ciNPWT) has been proposed as a strategy to reduce postoperative complications, including seroma formation. However, evidence in mastectomy without immediate reconstruction remains limited. <b>Methods:</b> A prospective observational single-center pilot study was conducted at Santâ??Andrea University Hospital (Rome). Twenty-two consecutive patients undergoing mastectomy for oncologic indications were treated with ciNPWT (PICO device) and compared with a historical cohort of 40 patients managed with standard dressings. Each breast was considered an independent unit of analysis. The primary endpoint was postoperative seroma, assessed clinically and quantified in milliliters. Secondary endpoints included hematoma, skin necrosis, ecchymosis, postoperative bleeding, reintervention, and device compliance. Follow-up was performed at 7 and 14 days postoperatively. <b>Results:</b> A total of 70 mastectomy units from 65 patients were analyzed (22 ciNPWT vs 48 controls). The ciNPWT group was significantly older (74.09 Ã+- 9.51 vs 65.71 Ã+- 14.12 years; p = 0.014) and had a higher proportion of axillary dissections. At 7 days, mean aspirated seroma volume was lower in the ciNPWT group (33.41 Ã+- 59.83 mL vs 44.58 +- 96.49 mL; p = 0.619), although not statistically significant. At 14 days, the ciNPWT group showed a significantly higher seroma volume (59.55 Ã+- 78.95 mL vs 17.02 Ã+- 40.17 mL; p = 0.025). Secondary complication rates were comparable between groups. No skin necrosis was observed. Device compliance was 100%. <b>Conclusions:</b> ciNPWT using the PICO device demonstrated excellent safety and tolerability. While an early trend toward reduced seroma was observed, a significant increase at 14 days suggests a possible rebound effect after device removal. Due to methodological limitations, definitive conclusions on efficacy cannot be drawn. These findings support the need for larger prospective randomized multicenter studies to clarify the role and optimal duration of ciNPWT in mastectomy patients.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 3","pages":"260-267"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Scope to Scalpel: A Review of the Timing and Outcomes of Conversion in Minimally Invasive Liver Resections.","authors":"Doaa Abdulaziz, Dinesh Sharma","doi":"10.21614/chirurgia.3247","DOIUrl":"10.21614/chirurgia.3247","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive liver resection (MILR), encompassing laparoscopic and robotic techniques, has transformed hepatobiliary surgery. Despite its advantages, intraoperative conversion to open surgery remains a critical event, often associated with increased blood loss, morbidity, and longer hospital stay. Timing of conversion - whether early or delayed - emerges as a key determinant of patient outcomes yet remains poorly defined in the literature. Aim: This review synthesizes current evidence on the indications, timing, and outcomes of conversion in MILR, with a focus on identifying risk factors, perioperative consequences, and existing knowledge gaps.</p><p><strong>Methods: </strong>A systematic search of PubMed, MEDLINE, and Embase was performed (2010-2025). We included studies comparing converted vs. non-converted MILR. A quantitative synthesis was performed for key outcomes.</p><p><strong>Results: </strong>Fifteen studies (15,834 patients) were included. A quantitative analysis revealed that conversion was associated with significantly increased blood loss (mean difference: 450 mL), higher overall morbidity (OR: 2.5), and longer hospital stays (mean difference: 4.2 days). We propose an operational definition: Early Conversion ( 60 mins or pre-parenchymal transection), **Late Conversion** ( 60 mins or post-parenchymal transection), and Emergency Conversion (life-threatening event). We propose operational definitions for conversion timing (Early, Late, Emergency) and developed a decision-making algorithm.</p><p><strong>Conclusions: </strong>Conversion during MILR is a pivotal safety measure, but its timing substantially influences outcomes. There is a pressing need for a national, prospective, multicentre UK-based audit to define optimal conversion timing, identify modifiable risk factors, and inform standardised intraoperative decision-making frameworks.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 Ahead of print","pages":"1-10"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148344007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Management of the Diabetic Foot in End-Stage Kidney Disease: An Integrated Anatomical, Nephrological and Vascular-Surgical Perspective.","authors":"Ioana Livia Suliman, Florin Gabriel Panculescu, Marius Florentin Popa, Constantin Dina, Lucian Serbanescu, Alexandru Vicentiu Valcu, Florin Daniel Enache, Teodor Stefan Nitu, Stere Popescu, Dragoş Fasie, Bogdan Campineanu, Liliana-Ana Tuta, Bogdan Obada","doi":"10.21614/chirurgia.3307","DOIUrl":"https://doi.org/10.21614/chirurgia.3307","url":null,"abstract":"<p><p>Diabetic foot disease in end-stage kidney disease (ESKD) represents the convergence of diabetic peripheral neuropathy, accelerated atherosclerosis, medial arterial calcification, uremic immune dysfunction and impaired wound healing. The combination yields amputation rates three- to five-fold higher than in non-uremic diabetics and one-year postamputation mortality approaching 40â?\"50%. In this paper we synthesised the current anatomical, diabetological, nephrological and surgical evidence into a practical framework for the surgeon caring for the dialysis-dependent or kidney-transplant recipient with a diabetic foot. We conducted a narrative review of guidelines and consensus statements from the American Diabetes Association (ADA) Standards of Care 2025, KDIGO 2022/2024, the 2023 intersocietal International Working Group on the Diabetic Foot (IWGDF), European Society for Vascular Surgery (ESVS) and Society for Vascular Surgery (SVS) PAD guideline, the 2024 ACC/AHA Lower-Extremity PAD Guideline, the 2019 Global Vascular Guidelines on chronic limb-threatening ischemia (CLTI), and the KDOQI 2019/2020 vascular access update, supplemented by high-quality reviews published through 2026. Anatomical understanding of the tibioperoneal trifurcation, pedal-plantar loop and the angiosomal territories is now central to revascularization planning; belowthe- knee disease in ESKD is diffuse, calcified and pedal-dominant, mandating individualized choice between bypass, endovascular and transcatheter arterialization of the deep veins; perioperative care must integrate dialysis timing, hyperkalaemia control, anaemia and mineral-bone disease management, and ipsilateral vascular-access preservation; the threshold to definitive, well-planned amputation should be lower than in non-uremic diabetics, but only after a structured limb-salvage attempt within a multidisciplinary \"toe-and-flow\" team.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 3","pages":"348-357"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}